Transcript Domestic Violence: The Relationship to Child Abuse and Neglect

Domestic Violence
I. Intimate Partner Violence:
A. Statement of the Problem
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Identified as one of the Nation’s Most Pressing
Public Health Problem.
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Women are more likely to be repeatedly attacked,
raped, injured or killed by male partner than by any
other type of perpetrator.
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Severe, serial nature enhanced by easy access,
high levels of exposure, privacy.
B. Definitions
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Physical Violence ranges from minor to
lethal violence.
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Push, hit, slap, shove
Assault with hands, objects weapons
Acts/Threats to maim kill pets, partner, family
Choke, strangle, bite, burn, throw down stairs
Sexual Assault and Rape
B. Definitions (con’t)
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Emotional Abuse and Coercion
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Restriction of routines, activities, relationships
Forced Isolation
Restriction of access to medical/MH care
Stalking and intense monitoring of behavior
Threatened loss of valued things
Threats to harm loved ones
Restricted access to $$, other support
B. Definitions (con’t)
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Verbal Abuse:
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Name Calling, Degradation/Insults
Intense Criticism.
AMA (1992) “…pattern of coercive behaviors
that may include repeated battering and injury,
psychological abuse, sexual assault, progressive
social isolation, deprivation and intimidation
perpetrated by someone who is or was involved in
an intimate relationship with the victim (p. 40).”
C. Epidemiology-Population Studies
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Rates vary by sample and definition.
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IPV affects 3-4 million women in the U.S.
annually (8-10%).
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Lifetime rates of IPV for American Women
range from 21-34% during adulthood.
C. Epidemiology-Risk Factors
Younger women at increased risk
 Single, separated, divorced higher rates
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Violence in dating/courtship increasing problem
(32% in large national college sample)
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High School dating: 13-25%
Fewer years married higher rates
C. Epidemiology-Risk Factors
IPV cuts across socioeconomic lines.
 Higher rates associated with poverty, e.g,
60% lifetime prevalence in AFDC sample.
 BJS-highest rates w/lowest income, 12
per1,000 (Black) and 8 per 1,000 (White).
 Trapped by Abuse, Trapped by Poverty.
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C. Epidemiology-Specialized Samples
Primary Care: 44-46% during lifetime.
 All female E.D. patients: 54% in lifetime
 OB samples: up to 37% during pregnancy.
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Pregnant Women (Nat’l Sample):
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154/1,000 1st-4th month of pregnancy
170/1,000 6th-9th month of pregnancy
Increased violence reported during pregnancy
D. Patterns/Dynamics
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All Abusive Behavior Functions to Maintain
Domination, Power and Control.
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Physical abuse tends to occur w/ verbal and
emotional abuse.
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Emotional/verbal abuse often precedes
physical violence
D. Patterns/Dynamics
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Abuse tends to escalate in Frequency and Severity
over time.
Perceived/Actual Separation Increased Risk of
Assault and Lethal Outcomes
Stalking as a variant of IPV
“Why Doesn’t She Just Leave?”(Most Do)
– Leaving is a process, not an event (Average 6x)
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“Why Doesn’t He Just Let Her Go?”
C. Patterns/Dynamics
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Help-seeking Behaviors/Coping
– BW engage in an extensive number and array of
help-seeking behaviors. They are NOT passive.
– These efforts often do not “work, ” in terms of
stopping the violence or improving the situation.
– Initially women cope by trying to control/prevent
the violence - eventually their coping turns to
simply surviving it (can appear maladaptive)
G. Assessment and Intervention
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Components of Assessment/Intervention:
– Assess abuse (informal and formal)
– Lethality Assessment (AAS, Campbell)
– Development of a safety plan (AWARE Guide)
– Provide Information about Resources (in a format
that is safe and accessible if she is in danger)
– Help her access local resources
G. Assessment/Intervention: Asking Q’s
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Safety is paramount
– Interview the victim in a private place
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Create an atmosphere of trust.
– Build trust by listening without judging, avoid
“Why” questions.
– Begin with less threatening questions.
– Notice that she may feel shame,fear,ambivalence
and validate feelings “this is hard to talk about…”
G. Assessment/Intervention: Asking Q’s
Ask Direct questions beginning with
questions about how she and her partner
handle conflict. Ask if she has ever been
treated badly, felt scared, or scared for her
children, if her partner ever damaged her
things, kept her from loved ones or access to
money. (see handouts for examples)
 Observe Behavior: signs of fear, trauma, etc.
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G. Assessment and Intervention
It is not uncommon for battered women to
deny or minimize the violence.
 Other complaints, like depression, sleep
problems or injuries can be clues.
 Consider speaking to friends or relatives.
 Remind her that she is not alone and that
help is available.
 Don’t Interrogate her if she denies/minimizes.
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G. Assessment and Intervention
Consider that her reluctance to report may be
protective of herself and her children.
 Expect the process to be slow and frustrating
 Anticipate that the victim may return many
times (6 on average) to the abuser.
 Support her efforts to become independent
and empowered to make healthy decisions
for herself and her family.
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G. Assessment:Unhelpful Responses
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Responses from Professional Perceived as
Unhelpful (Physical Violence) (Coates &
Hamilton, 1992) :
– Criticized me for staying
– Suggested couple’s counseling
– Went along with me when I said it wasn’t serious
– Questioned the truth of my story
G. Assessment: Unhelpful Responses
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Responses from Professional Perceived as
Unhelpful (Emotional Abuse):
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Gave me advice which I did not wish to follow.
Did not tell me other other agency or professional
services that could help me.
Did not listen carefully.
Did not have an accepting attitude.
G. Assessment: Unhelpful Responses
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Responses from Professional Perceived as
Unhelpful (Sexual Abuse):
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Questioned my story.
Denied the impact it had on my life.
Suggested I wanted it.
Blamed me for what happened.
G. Assessment and Intervention
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Options:
– Shelter
– Order of Protection
– Counseling
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Conjoint Therapy highly controversialappropriate only under very restricted
conditions.
G. Children: Special Issues for Intervention
Custody, mediation, court-ordered visitation
 “He’s a great dad, he just beats his wife”
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H. Batterers
Typology of Batterers
 Effectiveness of Batterers Intervention
Programs
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I. Special Issues: IPV in Workplace
Largely unaddressed
 Bureau of National Affairs (1990) estimated
that domestic violence costs employers $3-5
million/year in:
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Reduced productivity costs
Staff turnover.
Increased Health Costs.
I. Special Issues: IPV in Workplace
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Signs: Subtle
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Tardiness
Frequent unexplained absences
Problems w/concentration and attention
Fatigue, depression, anxiety, fear.
Excessive use of telephone
Unexplained injuries
I. Special Issues: IPV in Workplace
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Research Findings, 1992 Study 118 BW:
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19% of unemployed, prevented from working.
96% of employed reported some problem in the
work place due to abuse.
70% too distracted by violence to perform well.
60% reprimanded for abuse related problems.
70%+ telephoned excessively by abuser.
50%+ missed workdays,30% lost jobs